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General NPI Number Information
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NPI Number | 1558613406
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Entity Type | Individual
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Provider Name | TAMARA HICKS MS, LCMHC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 5501 EXECUTIVE CENTER DR STE 217
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City | CHARLOTTE
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State | NC
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Zip | 28212-8823
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Country | US
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Telephone | 980-949-8811
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Fax | 980-406-3878
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Provider Business Mailing Address
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Address Line | 16948 COMMONS CREEK DR
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City | CHARLOTTE
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State | NC
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Zip | 28277-2077
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Country | US
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Telephone | 980-949-8811
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Fax | 980-406-3878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 12067
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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